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How Is Gout Diagnosed in Adults?

Gout is the most common form of inflammatory arthritis, affecting more than one percent of the population.1 However, it can be difficult to accurately diagnose because its symptoms can be similar to those of other diseases.2 To make matters more complicated, not every gout patient experiences the same symptoms.2 So, how is gout diagnosed?

Symptoms

If you’ve ever had a gout flare (also known as a gout attack), it probably took you by surprise. They seem to happen very suddenly, often in the middle of the night.3 Many people who experience gout for the first time are awakened from a sound sleep with the sensation that one of their joints (often the big toe) is on fire.3 The most common symptoms of gout include:

Intense joint pain. For most people, gout strikes first in the large joint of the big toe.3 However, it can occur in any joint.3 Those most commonly affected (after the big toe) include the ankles, knees, elbows, wrists and fingers.3 The pain typically is at its worst within the first four to 12 hours after the flare begins.3

Nagging discomfort. Within the first four to 12 hours after a flare, the more severe pain begins to subside.3 However, joint discomfort may linger for as long as a few weeks. Subsequent attacks may last even longer and affect more joints.3

Swelling and redness. During a flare, the affected joint can become swollen, tender, warm and red.3

Limited range of motion. As your gout progresses, you may not be able to move your joints as you once did.3

Contact your doctor

If you suspect you have gout, make an appointment with your doctor as soon as possible.3 After your initial examination, your doctor may want to refer you to a rheumatologist (a specialist who focuses on patients with arthritis and other inflammatory joint conditions). But don’t wait—untreated gout can become increasingly painful and result in joint damage.3 Talk to your doctor about whether prescription medications to prevent gout flares like colchicine may be right for you.

Gout tests

To determine if you have gout, your doctor will probably examine you and ask questions about your symptoms and lifestyle. Your doctor may also perform one or more of the following tests:

Joint fluid test. This test uses a needle to remove fluid from the affected joint.5 The fluid is then examined under a microscope for urate crystals.5 (It is worth noting, however, that the absence of crystals does not necessarily mean a person does not have gout.2)

Blood test. In this test, the uric acid level in your body is measured using a sample of your blood.5 A uric acid level of 7 mg/dL is considered high, but not everyone with a high uric acid level has gout.6 Some people with high uric acid levels never have gout symptoms.5 On the other hand, some people may have a low uric acid level when they are right in the middle of an acute attack.4

X-ray. This test typically is used to rule out other causes of joint inflammation.5

Musculoskeletal ultrasound. This test is used to detect urate crystals in a joint or in a tophus5 (a hard uric acid deposit that is visible under the skin6). It is more commonly performed in Europe than in the US.5

Dual energy CT scan. This test is used to detect urate crystals in a joint, even if the joint is not acutely inflamed.5 It is often expensive, not widely available and not routinely used in clinical practice.5

Urine test. This test, which measures the uric acid level in the urine, typically requires a 24-hour urine sample.7

Prepare for your appointment

Before you visit your doctor, consider the following4:

Your symptoms. When did you first notice your symptoms? What were they? How often did/do they occur? Your doctor will be interested in these and other key details.

Changes or stressors. Have you recently experienced any major changes in your life? How’s your stress level lately? This kind of information may be helpful to your doctor and is worth mentioning during your appointment.

Key medical information. What other medical conditions do you have? Although your doctor has your chart, it may be a good idea to remind him or her of any other health issues you have. You should also be prepared to list the names of the medications, vitamins, supplements and other treatments you currently take.

Your questions. What do you want to know about gout? Make the most of your time with the doctor by taking a few minutes to write down your questions beforehand.

You might consider asking your spouse or a close friend to go with you to your appointment.4 It may be difficult to remember everything you discuss with your doctor, even if you take notes.4 Plus, you might appreciate the emotional support of a friend or loved one.4

NOTE:This article was not written by a medical professional and is not intended to substitute for the guidance of a physician. These are not West-Ward’s recommendations for gout flare prevention, but rather facts and data collected from various reliable medical sources. For a full list of resources and their attributing links, see below.

Colchicine 0.6 mg capsules are contraindicated in patients with renal or hepatic impairment who are currently prescribed drugs that inhibit both P-gp and CYP3A4. Combining these dual inhibitors with colchicine in patients with renal or hepatic impairment has resulted in life-threatening or fatal colchicine toxicity. Patients with both renal and hepatic impairment should not be given Mitigare®.

Fatal overdoses have been reported with colchicine in adults and children. Keep Mitigare® out of the reach of children.

Blood dyscrasias such as myelosuppression, leukopenia, granulocytopenia, thrombocytopenia, and aplastic anemia have been reported with colchicine used in therapeutic doses.

Monitor for toxicity and if present consider temporary interruption or discontinuation of colchicine.

Drug interaction with dual P-gp and CYP3A4 inhibitors: Co-administration of colchicine with dual P-gp and CYP3A4 inhibitors has resulted in life-threatening interactions and death.

Neuromuscular toxicity and rhabdomyolysis may occur with chronic treatment with colchicine in therapeutic doses, especially in combination with other drugs known to cause this effect. Patients with impaired renal function and elderly patients (including those with normal renal and hepatic function) are at increased risk. Consider temporary interruption or discontinuation of Mitigare®.

The most commonly reported adverse reactions with colchicine are gastrointestinal symptoms, including diarrhea, nausea, vomiting, and abdominal pain.

Indication

Mitigare® is indicated for prophylaxis of gout flares in adults. The safety and effectiveness of Mitigare for acute treatment of gout flares during prophylaxis has not been studied.

Mitigare® is not an analgesic medication and should not be used to treat pain from other causes.

Colchicine 0.6 mg capsules are contraindicated in patients with renal or hepatic impairment who are currently prescribed drugs that inhibit both P-gp and CYP3A4. Combining these dual inhibitors with colchicine in patients with renal or hepatic impairment has resulted in life-threatening or fatal colchicine toxicity. Patients with both renal and hepatic impairment should not be given Mitigare®.

Fatal overdoses have been reported with colchicine in adults and children. Keep Mitigare® out of the reach of children.